Tai Chi for Chronic Illness Management: Synthesizing Current Evidence from Meta-Analyses of Randomized Controlled Trials

Published:September 15, 2020DOI:


      An umbrella review of systematic reviews and meta-analyses of randomized controlled trials (RCTs) was conducted to evaluate the existing evidence of Tai Chi as a mind-body exercise for chronic illness management. MEDLINE/PubMed and Embase databases were searched from inception until March 31, 2019, for meta-analyses of at least two RCTs that investigated health outcomes associated with Tai Chi intervention. Evidence of significant outcomes (P value < 0.05) was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.
      This review identified 45 meta-analyses of RCTs and calculated 142 summary estimates among adults living with 16 types of chronic illnesses. Statistically significant results (P value < 0.05) were identified for 81 of the 142 outcomes (57.0%), of which 45 estimates presenting 30 unique outcomes across 14 chronic illnesses were supported by high (n = 1) or moderate (n = 44) evidence. Moderate evidence suggests that Tai Chi intervention improved physical functions and disease-specific outcomes compared with nonactive controls and improved cardiorespiratory fitness compared with active controls among adults with diverse chronic illnesses. Between-study heterogeneity and publication bias were observed in some meta-analyses.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Pan H
        • Pei Y
        • Li B
        • Wang Y
        • Liu J
        • Lin H
        Tai Chi Chuan in postsurgical non-small cell lung cancer patients: study protocol for a randomized controlled trial.
        Trials. 2018; 19: 2
        • Zou L
        • Loprinzi PD
        • Yu JJ
        • et al.
        Superior effects of modified Chen-style Tai Chi versus 24-style Tai Chi on cognitive function, fitness, and balance performance in adults over 55.
        Brain Sci. 2019; 9: 2
        • Ainsworth BE
        • Haskell WL
        • Herrmann SD
        • et al.
        2011 compendium of physical activities: a second update of codes and MET values.
        Med Sci Sports Exerc. 2011; 43: 1575-1581
        • Li F
        • Harmer P
        • Fitzgerald K
        • et al.
        Tai chi and postural stability in patients with Parkinson's disease.
        N Engl J Med. 2012; 366: 511-519
        • Wang C
        • Schmid CH
        • Rones R
        • et al.
        A randomized trial of tai chi for fibromyalgia.
        N Engl J Med. 2010; 363: 743-754
        • Wang C
        • Schmid CH
        • Fielding RA
        • et al.
        Effect of Tai Chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial.
        BMJ. 2018; 360: k851
        • Wang C
        • Schmid CH
        • Hibberd PL
        • et al.
        Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial.
        Arthritis Rheum. 2009; 61: 1545-1553
        • Yeh GY
        • McCarthy EP
        • Wayne PM
        • et al.
        Tai Chi exercise in patients with chronic heart failure: a randomized clinical trial.
        Arch Intern Med. 2011; 171: 750-757
        • Tsang T
        • Orr R
        • Lam P
        • Comino E
        • Singh MF
        Effects of Tai Chi on glucose homeostasis and insulin sensitivity in older adults with type 2 diabetes: a randomised double-blind sham-exercise-controlled trial.
        Age Ageing. 2008; 37: 64-71
        • Irwin MR
        • Olmstead R
        • Carrillo C
        • et al.
        Tai Chi Chih compared with cognitive behavioral therapy for the treatment of insomnia in survivors of breast cancer: a randomized, partially blinded, noninferiority trial.
        J Clin Oncol. 2017; 35: 2656-2665
        • Wang L
        • Wu K
        • Chen X
        • Liu Q
        The effects of Tai Chi on lung function, exercise capacity and health related quality of life for patients with chronic obstructive pulmonary disease: a pilot study.
        Heart Lung Circ. 2019; 28: 1206-1212
        • Au-Yeung SS
        • Hui-Chan CW
        • Tang JC
        Short-form Tai Chi improves standing balance of people with chronic stroke.
        Neurorehabil Neural Repair. 2009; 23: 515-522
        • Tao J
        • Liu J
        • Liu W
        • et al.
        Tai Chi Chuan and Baduanjin increase grey matter volume in older adults: a brain imaging study.
        J Alzheimers Dis. 2017; 60: 389-400
        • Chan AWK
        • Chair SY
        • Lee DTF
        • et al.
        Tai Chi exercise is more effective than brisk walking in reducing cardiovascular disease risk factors among adults with hypertension: A randomised controlled trial.
        Int J Nurs Stud. 2018; 88: 44-52
        • Ioannidis J
        Next-generation systematic reviews: prospective meta-analysis, individual-level data, networks and umbrella reviews.
        Br J Sports Med. 2017; 51: 1456-1458
        • Ioannidis JP
        Integration of evidence from multiple meta-analyses: a primer on umbrella reviews, treatment networks and multiple treatments meta-analyses.
        CMAJ. 2009; 181: 488-493
        • Moher D
        • Liberati A
        • Tetzlaff J
        • Altman DG
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        PLoS Med. 2009; 6e1000097
        • Lau J
        • Ioannidis JP
        • Schmid CH
        Quantitative synthesis in systematic reviews.
        Ann Intern Med. 1997; 127: 820-826
        • Higgins JP
        • Thompson SG
        Quantifying heterogeneity in a meta-analysis.
        Stat Med. 2002; 21: 1539-1558
        • Egger M
        • Davey Smith G
        • Schneider M
        • Minder C
        Bias in meta-analysis detected by a simple, graphical test.
        BMJ. 1997; 315: 629-634
        • Guyatt GH
        • Oxman AD
        • Vist GE
        • et al.
        GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.
        BMJ. 2008; 336: 924
        • Whiting P
        • Savovic J
        • Higgins JP
        • et al.
        ROBIS: a new tool to assess risk of bias in systematic reviews was developed.
        J Clin Epidemiol. 2016; 69: 225-234
        • Riebe D
        • Ehrman JK
        • Liguori G
        • Magal M
        • American College of Sports Medicine
        ACSM’s Guidelines for Exercise Testing and Prescription. 2018;
        • Church TS
        • Blair SN
        • Cocreham S
        • et al.
        Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial.
        JAMA. 2010; 304: 2253-2262
        • Marzolini S
        • Oh P
        • McIlroy W
        • Brooks D
        The effects of an aerobic and resistance exercise training program on cognition following stroke.
        Neurorehabil Neural Repair. 2013; 27: 392-402
        • Bergenthal N
        • Will A
        • Streckmann F
        • et al.
        Aerobic physical exercise for adult patients with haematological malignancies.
        Cochrane Database Syst Rev. 2014; CD009075
        • Brellenthin AG
        • Lanningham-Foster LM
        • Kohut ML
        • et al.
        Comparison of the Cardiovascular Benefits of Resistance, Aerobic, and Combined Exercise (CardioRACE): rationale, design, and methods.
        Am Heart J. 2019; 217: 101-111
        • Sigal RJ
        • Alberga AS
        • Goldfield GS
        • et al.
        Effects of aerobic training, resistance training, or both on percentage body fat and cardiometabolic risk markers in obese adolescents: the healthy eating aerobic and resistance training in youth randomized clinical trial.
        JAMA Pediatr. 2014; 168: 1006-1014
        • Lui PP
        • Qin L
        • Chan KM
        Tai Chi Chuan exercises in enhancing bone mineral density in active seniors.
        Clin Sports Med. 2008; 27 (viii): 75-86
        • Butland RJ
        • Pang J
        • Gross ER
        • Woodcock AA
        • Geddes DM
        Two-, six-, and 12-minute walking tests in respiratory disease.
        Br Med J. 1982; 284: 1607-1608
        • Mandsager K
        • Harb S
        • Cremer P
        • Phelan D
        • Nissen SE
        • Jaber W
        Association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing.
        JAMA Network Open. 2018; 1 (e183605-e183605)
        • Kodama S
        • Saito K
        • Tanaka S
        • et al.
        Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis.
        JAMA. 2009; 301: 2024-2035
        • Wei GX
        • Li YF
        • Yue XL
        • et al.
        Tai Chi Chuan modulates heart rate variability during abdominal breathing in elderly adults.
        Psych J. 2016; 5: 69-77
        • Lu WA
        • Kuo CD
        Breathing frequency-independent effect of Tai Chi Chuan on autonomic modulation.
        Clin Auton Res. 2014; 24: 47-52
        • Seo K
        • Hwan PS
        • Park K
        The effects of inspiratory diaphragm breathing exercise and expiratory pursed-lip breathing exercise on chronic stroke patients’ respiratory muscle activation.
        J Phys Ther Sci. 2017; 29: 465-469
        • Aliverti A
        The respiratory muscles during exercise.
        Breathe (Sheff). 2016; 12: 165-168
        • Gopaladhas S
        • Panigraph A
        • Chinnavan E
        • Ragupathy R
        Effectiveness of resisted abdominal exercise versus resisted diaphragmatic breathing exercise on cardiovascular endurance in sports men.
        Int J Med Res Health Sci. 2014; 3: 785-789
        • Yong MS
        • Lee HY
        • Lee YS
        Effects of diaphragm breathing exercise and feedback breathing exercise on pulmonary function in healthy adults.
        J Phys Ther Sci. 2017; 29: 85-87
        • Ladawan S
        • Klarod K
        • Philippe M
        • et al.
        Effect of Qigong exercise on cognitive function, blood pressure and cardiorespiratory fitness in healthy middle-aged subjects.
        Complement Ther Med. 2017; 33: 39-45
        • Strick L
        Breathing and physical fitness exercises for asthmatic children.
        Pediatr Clin North Am. 1969; 16: 31-42
        • Westerdahl E
        Optimal technique for deep breathing exercises after cardiac surgery.
        Minerva Anestesiol. 2015; 81: 678-683
        • Hartvigsen J
        • Hancock MJ
        • Kongsted A
        • et al.
        What low back pain is and why we need to pay attention.
        Lancet. 2018; 391: 2356-2367
        • Blyth FM
        • Briggs AM
        • Schneider CH
        • Hoy DG
        • March LM
        The global burden of musculoskeletal pain-where to from here?.
        Am J Public Health. 2019; 109: 35-40
        • Chandra PS
        • Chand P
        Towards a new era for mental health.
        Lancet. 2018; 392: 1495-1497
        • Hall AM
        • Kamper SJ
        • Emsley R
        • Maher CG
        Does pain-catastrophising mediate the effect of tai chi on treatment outcomes for people with low back pain?.
        Complement Ther Med. 2016; 25: 61-66
        • Chen KW
        • Comerford A
        • Shinnick P
        • Ziedonis DM
        Introducing qigong meditation into residential addiction treatment: a pilot study where gender makes a difference.
        J Altern Complement Med. 2010; 16: 875-882
        • Zou L
        • Yeung A
        • Li C
        • et al.
        Effects of meditative movements on major depressive disorder: a systematic review and meta-analysis of randomized controlled trials.
        J Clin Med. 2018; 7: 195
        • Perciavalle V
        • Blandini M
        • Fecarotta P
        • et al.
        The role of deep breathing on stress.
        Neurol Sci. 2017; 38: 451-458
        • Jerath R
        • Crawford MW
        • Barnes VA
        • Harden K
        Self-regulation of breathing as a primary treatment for anxiety.
        Appl Psychophysiol Biofeedback. 2015; 40: 107-115
        • Brown RP
        • Gerbarg PL
        • Muench F
        Breathing practices for treatment of psychiatric and stress-related medical conditions.
        Psychiatr Clin North Am. 2013; 36: 121-140
        • Zou L
        • Zhang Y
        • Liu Y
        • et al.
        The effects of Tai Chi Chuan versus core stability training on lower-limb neuromuscular function in aging individuals with non-specific chronic lower back pain.
        Medicina (Kaunas). 2019; 55: 60
        • Liu J
        • Yeung A
        • Xiao T
        • et al.
        Chen-Style Tai Chi for individuals (aged 50 years old or above) with chronic non-specific low back pain: a randomized controlled trial.
        Int J Environ Res Public Health. 2019; 16: 517
        • Liu J
        • Tao J
        • Liu W
        • et al.
        Different modulation effects of Tai Chi Chuan and Baduanjin on resting-state functional connectivity of the default mode network in older adults.
        Social Cogn Affect Neurosci. 2019; 14: 217-224
        • Zhou M
        • Liao H
        • Sreepada LP
        • Ladner JR
        • Balschi JA
        • Lin AP
        Tai Chi improves brain metabolism and muscle energetics in older adults.
        J Neuroimaging. 2018; 28: 359-364
        • Xie H
        • Zhang M
        • Huo C
        • Xu G
        • Li Z
        • Fan Y
        Tai Chi Chuan exercise related change in brain function as assessed by functional near-infrared spectroscopy.
        Sci Rep. 2019; 9: 13198
        • Zhang HW
        • Zheng R
        • Xu C
        • et al.
        Tai Chi for improving recovery after stroke.
        Cochrane Database Syst Rev. 2018; CD010207
        • Li F
        • Fisher KJ
        • Harmer P
        • Shirai M
        A simpler eight-form easy Tai Chi for elderly adults.
        J Aging Phys Activity. 2003; 11: 206-218
        • Yang Y
        • Decelle S
        • Reed M
        • Rosengren K
        • Schlagal R
        • Greene J
        Subjective experiences of older adults practicing Taiji and Qigong.
        J Aging Res. 2011; 2011650210
        • Yang Y
        • Verkuilen JV
        • Rosengren KS
        • Grubisich SA
        • Reed MR
        • Hsiao-Wecksler ET
        Effect of combined Taiji and Qigong training on balance mechanisms: a randomized controlled trial of older adults.
        Med Sci Monit. 2007; 13: CR339-CR348
        • Reis RS
        • Salvo D
        • Ogilvie D
        • Lambert EV
        • Goenka S
        • Brownson RC
        Scaling up physical activity interventions worldwide: stepping up to larger and smarter approaches to get people moving.
        Lancet. 2016; 388: 1337-1348